ADHD: between brain, genetics and society
ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder characterised by a specific difference in the way the brain handles activities such as attention, energy and impulsivity. Talking about it is Doctor Massimiliano Dieci, psychiatrist and head of the U.O. of Psychiatric Rehabilitation and ZucchiMental Care, specialised in psychiatric care and addiction at the Zucchi Clinical Institutes of Gruppo San Donato in Carate Brianza.
What it is and why it occurs
"On a neurobiological level, ADHD is linked to a dysfunction of the dopaminergic and noradrenergic systems. That is, it is an alteration that impairs the brain circuits involved in the regulation of attention and the ability to plan. The causes are multifactorial, but genetics plays a major role. In addition to this, there are possible factors such as premature birth and exposure to toxic substances such as smoking, alcohol or other substances during pregnancy'.
Diagnosis on the rise: why?
'In Italia and worldwide we are seeing an increase in diagnoses. Epidemiological data speak of around 4% in children and adolescents and 3% in adults, with a male prevalence especially in the lower age groups. This increase is linked to a greater ability to intercept cases and to the digital context that exposes us to rapid and continuous stimuli, such as online video games and social networks, which could influence attention levels. It is, however, still a much debated issue in the scientific community'.
Severe forms and mild forms
'ADHD is not an "all or nothing" condition, it is distributed along a continuum of severity. We can observe mild, so-called subclinical forms, in which symptoms are present but manageable, allowing for an almost normal daily life; and more severe forms, where there is a marked difficulty in controlling impulsivity and attention, with a significant impact on school, work and social performance".
ADHD from childhood to adulthood
"Although the onset is typically in childhood, the diagnosis can also come much later. This depends on the level of attention in the context, the individual's ability to compensate, e.g. in high IQ individuals, and the presence of inattentive symptoms, which are less pronounced than in hyperactivity.
The hypothesis of an onset in adulthood is still the subject of scientific debate. The most widely accepted interpretation is that these are milder forms that were not previously recognised'.
"While in children hyperactivity is often a strategy to seek stimulation and maintain cognitive activation, in adults the disorder tends to become predominantly inattentive. The most common symptoms include:
- difficulty maintaining concentration on prolonged activities, such as reading or meetings;
- problems with time management and planning;
- tendency to lose objects;
- a constant feeling of mental overload.
Associated risks and comorbidities
"ADHD rarely presents alone: it is associated with other neurodevelopmental disorders, such as specific learning or autism spectrum disorders. In addition, it is a risk factor for several psychiatric conditions in adulthood, including anxiety, bipolar disorder and di personalities, such as borderline and antisocial. A greater vulnerability to addictions, particularly to stimulant substances, is also common".
The diagnostic pathway: avoiding 'fads'
"Although there is a lot of talk about it, we are not facing a fad. On the contrary, in Italy only a small proportion of the people who would need it receive a proper diagnosis and treatment. Diagnosis is exclusively clinical: there are no blood tests or biomarkers that can replace specialist evaluation.
It is essential to turn to expert child psychiatrists or neuropsychiatrists, who are able not only to assess current symptoms, but also to reconstruct the patient's school, relational and behavioural history, in order to distinguish ADHD from other conditions and avoid the risk of over-diagnosis'.
Treatment and perspectives
"The management of ADHD is most effective when based on an integrated approach," explains the psychiatrist, "through:
- drugs such as Methylphenidate and Atomoxetine, which help to regulate dopamine and noradrenaline levels, improving concentration;
- cognitive-behavioural psychotherapy, which is essential to develop practical strategies for organising and managing daily life;
- lifestyle modifications, physical activity and proper nutrition coupled with mindfulness techniques can improve attention regulation'.
A tip for parents
"Being diagnosed with ADHD does not mean you are seriously ill. Many people with ADHD present a sharp creativity and divergent thinking. These are characteristics that, if properly addressed, can become a strength. It is no coincidence that large international companies have started to value these profiles'.
